保存下颌骨及下颌关节功能的成釉细胞瘤手术新方法  

Application of The Internal Fixation With Supporting-style Titaniumplate in The Expanding Curettage of The Mandibular Ameloblastoma

作　　者：郭纪明[1] 邱建忠[1] 陈正岗[1] 潘洪祥[1] 伊丽[1] 

机构地区：[1]青岛市市立医院,266011

出　　处：《青岛医药卫生》2003年第2期98-100,共3页Qingdao Medical Journal

摘　　要：目的探索一种既能彻底切除肿瘤、防止复发,又能保存下颌骨连续性及颞颌关节功能的下颌骨成釉细胞瘤手术新方法。方法对X线影像显示病变波及几乎整个下颌骨升支部、角部甚至部分下颌骨体部的较大的单房型成釉细胞瘤病例,先尽量做到完整摘除肿瘤并扩大刮除骨腔内壁,再施以液氮冻融处理。为预防术区薄弱骨板处极可能发生的下颌骨病理性骨折,加用长条状钛板支撑式内固定。钛板一端固定于下颌骨体部,另一端弯制成类似直角形,以钛螺钉固定于髁状突颈部下方或下颌骨升支后缘的骨腔内壁。如术中下颌骨下缘发生骨折,则另以4-6孔微型钛板内固定,并注意保留该处骨膜。固定钛板前参照牙齿咬合关系先行手法复位,并在预先安装好的上下颌牙弓夹板上行颌间固定。术后颌间固定保持两周。结果 1997年以来共治疗2例,经2-5年以上定期随访及临床X线复查,2例病人均未见肿瘤复发,颌面部外形对称,开闭口运动正常,语言及咀嚼运动良好。X线显示原病理性骨折处完全愈合,新骨增生,皮质骨形成,原术后之骨腔明显缩小,内固定之钛板牢固。结论该方法对较大的下颌骨成釉细胞瘤可以保存完整对称的颞下颌关节功能及下颌骨的连续性,避免了根治性手术中的下颌骨截骨术及自体植骨术,大大减轻了面部畸形和功能障碍,经初步观察无复发。Objective To explore a new method which can not only completely excise the ameloblastoma avoiding recurrence .but also maintain the mandibular contour. Methods For the tumor located in ramus and angle even in the body part of the mandible with crusty mono-cavity changes in X-ray,complete resection followed by freezing with liquid nitrogen should be expanded with removing the internal surface in the cavity. The part where fracture will probably occur should be supported with a slim titaniumplate internally. One end is fixed in the mandibular body and another is adjusted to be alike a perpendicular angle fixed on the internal surface of the cavity or posterior edge of the ramus or under the neck of the condyle. Mini titaniumplate with 4-6 foramina should be suppled if there is fracture and the periosteum should be reserved. Hand-controlled replacement according to the occluding relation should be taken before plate-fixation and intermaxillary-fixation which should be kept for 2 weeks. Antibiotics should be applied at the same time. Results Contour symmetry of the maxillofacial part,normal open-close occlusive movement, linguistic and masticatory function are regained for 2 patients without recurrence after 2-5 years' regular clinical examination since 1997. X-ray shows that the fractured prt recovered completely,new osteon created, the cavity defect decreased conspicuously,the fixation is rigid. Conclusion Without mandibular resection and bone implantation, the new method can provide mandibular symmetry and continuity for the bigger cases with mural ameloblastoma and lessen the malfomation and malfuction. No recurrence could be detected. It can also be applied for bigger cyst operation as well.

关 键 词：下颌手术 成釉细胞瘤 

分 类 号：R739.8[医药卫生—肿瘤]